DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20222186
Published: 2022-08-25

Distal radius fractures: a prospective study of the clinical and radiological outcomes in surgically managed patients

Tanveer Ali, Irfan U. Ashraf, Sayyidah A. T. N. Qazi, Imtiyaz A. Beigh

Abstract


Background: Objective of the research was to evaluate radiological and functional outcome in fractures of the distal radius treated by various surgical methods.

Methods: 89 patients with distal radius fractures were randomly divided into three groups according to a computer-generated table of randomization. 40 patients were managed by K wire fixation. 22 patients were managed by external fixator. 27 patients were managed by volar plating technique. Anatomical restoration was evaluated by posterior-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate radial height (RH), radial inclination (RI) and volar tilt (VT). Functional outcome was evaluated using Mayo scoring system.

Results: According to Mayo score, in K-wire group 72.5% (n=29) patients had excellent to good outcome, 17.5% (n=7) had fair outcome while as 10% (n=4) patients had poor outcome. In external fixator group 72.7% (n=16) patients had excellent to good outcome while as 27.3% (n=6) had fair outcome. In volar plating group 81.5% (n=22) patients had excellent to good outcome while as 18.5% (n=5) had fair outcome.

Conclusions: In our study we found that volar locked plating provides advantage in dorsally or volarly displaced intra-articular fractures with excellent to good radiological outcome. However, in type B (partial intra-articular fractures) fractures, volar locking compression plate (LCP) and external fixator provide almost equivocal results. Percutaneous pinning can be recommended for extra-articular or simple intra-articular fracture patterns, with a loss of volar and/or RI but without significant radial shortening.


Keywords


Distal radius fractures, K-wiring, External fixation, Volar plating

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References


Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691-7.

Song J, Yu A-X, Li Z-H. Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2015;8(10):17023-35.

Mauck BM, Swigler CW. Evidence-based review of distal radius fractures. Orthop Clin North Am. 2018;49(2):211-22.

Clayton RAE, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone density and severity of distal radial fractures. J Bone Joint Surg. 2019;91:613-9.

Bucholz RW, Heckman JD, Court-Brown C. Fractures of distal radius & ulna: Rockwood & Green’s Fractures in Adults. 6th edition. 2006.

Abulaban OA, Alrifai AI, Almosallam SA, Abulaban AA, Hamdi AS. Radiological Assessment of Surgical Treatment of Distal Radius Fractures among Patients at an Academic Center in Jeddah. Egyptian J Hospital Med. 2018;72(4):4343-8.

Chaudhary P, Shrestha BP, Khanal GK, Baral P, Shah AB, Das J. RCT comparing closed reduction and percutaneous versus open reduction and volar locking plate in treatment of distal radius fractures in adults. Int J Orthop Sci. 2017;3(2):678-81.

Refai HH, Basiony MM, Ahmed MBYS. Results of Treatment of Distal Radius Fracture in Geriatrics Patients using Closed Reduction and Percutaneous K. Wires Fixation in Aswan University, Egypt. Arch Orthop Rheumatol. 2019;2(1):42-50.

Geller L, Bernstein M, Carli A, Berry G, Reindl R, Harvey E. Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures. Can J Surg. 2009;52(5):161-6.

Dwyer CL, Crosby NE, Cooney T, Seeds W, Lubahn JD. Treating Unstable Distal Radius Fractures With a Nonspanning External Fixation Device: Comparison With Volar Locking Plates in Historical Control Group. Am J Orthop (Belle Mead NJ). 2017;46(5):344-52.

Masood K, Akhtar M, Qureshi KZ, Zahoor MU, Siraj M, Chaudhary MN, Zeb A. Radiological and Clinical Outcome of Distal Radial Fractures Managed by Variable Angle 2.4 mm Titanium Volar Plate. Orthop Muscular Syst. 2016;5:222.

Mattila VM, Huttunen TT, Sillanpää P, Niemi S, Pihlajamäki H, Kannus P. Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma. 2011;71(4):939-42.

Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence? J Bone Joint Surg Am. 2008;90(9):1855-61.

Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg (Am). 2009;91:1868-73.